Hepatitis A Precautions and Management
Immediate Transmission Prevention Measures
Patients with positive hepatitis A must implement strict hand hygiene, avoid food handling for at least 1 week after jaundice onset, and notify all close contacts for immune globulin prophylaxis within 2 weeks of exposure. 1, 2
Personal Hygiene and Isolation
- Patients are most infectious 14 days before and 7 days after jaundice develops, making early identification of contacts critical 2
- Meticulous handwashing after using the bathroom and before any food preparation is essential, as HAV transmits via the fecal-oral route 3, 4
- Patients should not prepare food for others during the acute infectious period 3
- Standard enteric precautions should be maintained, though isolation beyond the first week after jaundice onset is typically unnecessary 5, 6
Contact Tracing and Prophylaxis
- All household members and sexual contacts must receive immune globulin (0.02 mL/kg) as soon as possible, ideally within 2 weeks of exposure 7, 1
- Persons who shared illicit drugs with the infected patient require both IG and hepatitis A vaccine 7, 1
- Regular babysitters and others with ongoing close personal contact should receive IG 7
- Healthcare workers do not routinely need IG unless an epidemiologic investigation confirms transmission 7
What Hepatitis A Does NOT Transmit Through
- HAV does not spread through sneezing, hugging, coughing, sharing eating utensils or drinking glasses, or casual contact 8, 4
- Patients should not be excluded from work, school, or childcare settings based solely on HAV status once the acute infectious period has passed 7
- Blood precautions are not the primary concern with hepatitis A, unlike hepatitis B or C 5
Clinical Management and Monitoring
Supportive Care
- Treatment is entirely supportive, as no specific antiviral therapy exists for hepatitis A 2, 4
- Up to 20% of patients experience prolonged or relapsing symptoms lasting up to 6 months 1
- Less than 1% develop acute liver failure, though case-fatality reaches 1.8% in adults over 50 years 1
Medication Review
- Patients should avoid starting any new medications, including over-the-counter and herbal products, without medical consultation during acute illness 7
- Alcohol should be completely avoided during the acute phase 9
Vaccination of the Infected Patient
- If the patient has chronic liver disease from any cause (hepatitis B, hepatitis C, cirrhosis), they should receive hepatitis A vaccine if not already immune, as superinfection can cause fulminant hepatitis 1, 9
- This recommendation applies even to the acutely infected patient once they recover, if they have underlying chronic liver disease 7
Prevention for Others
Who Needs Vaccination
- All children aged 12-23 months should receive routine hepatitis A vaccination 1
- High-risk adults requiring vaccination include: travelers to endemic areas, men who have sex with men, injection and non-injection drug users, persons with chronic liver disease, and those with clotting-factor disorders 1
Food Handler Considerations
- If the infected patient is a food handler, all other food handlers at the same establishment should receive IG 7
- Patrons typically do not need IG unless the food handler directly handled uncooked foods while having diarrhea or poor hygiene, and patrons can be identified within 2 weeks 7
Common Pitfalls to Avoid
- Do not delay IG administration to contacts while waiting for serologic confirmation—treat based on clinical suspicion, as the 2-week window is critical 7
- Do not screen contacts for immunity before giving IG, as this causes harmful delays 7
- Do not implement blood precautions as the primary isolation strategy—hepatitis A requires enteric precautions focused on fecal-oral transmission 5
- Do not assume patients remain highly infectious beyond 1 week after jaundice onset, though some viral shedding may continue 6, 2